Norbert Kang - Academia.edu (original) (raw)

Papers by Norbert Kang

Journal of Plastic Reconstructive and Aesthetic Surgery, Apr 1, 2007

Annals of The Royal College of Surgeons of England, Oct 1, 2014

Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extreme... more Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma's local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.

Journal of Plastic Reconstructive and Aesthetic Surgery, Oct 1, 2014

PubMed, Dec 1, 2000

Monoclonal antibodies (MAbs) against high-molecular-weight melanoma-associated antigen (HMW-MAA) ... more Monoclonal antibodies (MAbs) against high-molecular-weight melanoma-associated antigen (HMW-MAA) have been used in vivo to target melanoma. More recently, single chain Fv (scFv) antibody fragments against HMW-MAA have been described that may improve melanoma targeting. However, there have been few in vivo studies with antimelanoma scFvs because these have proved difficult to label with isotopes (e.g., 99mTc) suitable for imaging. We have generated a series of scFvs against HMW-MAA by chain shuffling and antibody phage selection on melanoma cells. In preliminary experiments we identified one scFv (RAFT3) as suitable for in vivo melanoma targeting. Direct radiolabeling of RAFT3 scFv with 99mTc was simple, yielding a radiochemical purity of >90%. The label remained stable for 24 h in vitro. 125I- and 99mTc-labeled RAFT3 scFv were tested in a nude mouse xenograft model for human melanoma and were compared with the parent MAb LHM2 and its F(ab')2 fragment versus nonmelanoma-specific MAb and scFv. RAFT3 scFv accumulated specifically in the tumor and showed greater tumor specificity compared with LHM2 with faster pharmacokinetics (t(1/2)alpha, 8 min; t(1/2)beta, 189 min; and t(1/2)alpha, 37 min; t(1/2)beta, 384 min, respectively) and reduced background in liver, lung, and spleen. Nonspecific accumulation of 99mTc-labeled RAFT3 scFv in the kidney was high but tumor:normal tissue ratios were better compared with 125I-labeled RAFT3 scFv and LHM2 F(ab')2. Overall, tumor-targeting efficiency at equivalent time points was scFv > IgG > F(ab')2 in good agreement with previously described scFvs engineered for 99mTc labeling. We discuss the potential use of RAFT3 scFv for imaging and therapy of metastatic melanoma.

The journal of hand surgery, Dec 1, 1997

We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery ... more We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery fasciocutaneous flap as described by Becker and Gilbert (1988a; b). Although the territory supplied by the dorsal ulnar artery is 10 cm to 20 cm long by 5 cm to 9 cm wide, Becker and Gilbert suggested that flapsshould be confined to smaller dimensions. We have found that larger flaps (15 to 20 cm long and 5 to 8 cm wide) are feasible, extending the use of the flap to the radial side of the wrist and hand. However, problems were encountered with venous drainage and these larger flaps should be used with caution.

Journal of Plastic Reconstructive and Aesthetic Surgery, Apr 1, 2011

Access to effective surgical treatments such as breast reduction is often restricted on the groun... more Access to effective surgical treatments such as breast reduction is often restricted on the grounds of patient obesity. However, there is a lack of unambiguous data on the surgical risks of obesity in patients undergoing breast reduction. The aim of this study was to assess the relationship between patient obesity, as determined by body mass index (BMI), and surgical outcome following bilateral breast reduction (BBR). Retrospective review of case notes was conducted for 306 patients who underwent BBR in our unit over a 5-year period. BMI, resection weight, smoking history, technique, complications and outcomes were determined from records of follow-up assessment. Overall complication rate was 53.9%, with multiple complications of 22.9%. A significant increase in complications after BBR with increasing BMI was identified (p = 0.019 any complication, p = 0.002 multiple complications). The effect of BMI on multiple complications was significant and independent of resection weight (p = 0.031) and reduction technique (p = 0.020). Smoking was associated with higher wound dehiscence and multiple complications. We developed a model for predicting risk of complications based on key variables. Despite higher complications, there was no significant difference in aesthetic outcome at follow-up between the BMI groups. These findings add to the body of evidence that obesity is associated with an increased risk of post-operative complications. This has implications for surgeons and healthcare payers. However the majority of complications were minor and aesthetic outcomes were satisfactory in the majority of cases. The use of a 'target' BMI as exclusion criteria should therefore be treated with caution.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2011

We examined variations in the shape of the human ear according to age, sex and ethnic group with ... more We examined variations in the shape of the human ear according to age, sex and ethnic group with particular attention to ear prominence. 420 volunteers were recruited. Measurements included; head height and length, ear height and axis, antihelix taken off angle, earlobe length and width, ear width at the helical root and tragus. Prominence was measured at the helical root and tragus (conchomastoid angle, conchal bowl depth and helical-mastoid distance). Good symmetry was shown for all measurements. Ethnically Indian volunteers had the largest ears (both length and width), followed by Caucasians, and Afro-Caribbeans. This trend was significant in males (p<0.001), but not significant in females (p=0.087). Ears increased in size throughout life. Subjectively, only 2% of volunteers felt their ears were prominent compared to 10% in the opinion of the principal investigator. No objective measurements were identified that accurately predicted subjective perceptions of prominence. We found consistent trends in ear morphology depending on ethnic group, age and sex. Our study was unable to define an objective method for assessing ear prominence. Decisions about what constitutes a prominent ear should be left to personal and aesthetic choice.

Jpo Journal of Prosthetics and Orthotics, Mar 31, 2022

ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated im... more ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.

Journal of Hand and Microsurgery, Sep 29, 2021

Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bon... more Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008–2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature. Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data. Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study). Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.

Orthopaedic Proceedings, May 1, 2012

Problems associated with soft tissues of the stump and attachment of prosthetic devices for amput... more Problems associated with soft tissues of the stump and attachment of prosthetic devices for amputees remains a considerable problem. These problems are associated with the transmission of load through the soft tissues of the stump and difficulty in attaching the prosthetic device. Several devices have an osteointegrated transcutaneous prosthesis attached to the residual bone onto which an exo-prostheses is secured thereby transmitting load directly through the skeleton. Infection of these devices is a key issue. A biomimetic intraosseous transcutaneous device for amputees known as ITAP has been developed which is based on deer antler morphology. We have shown that in deer antlers the dermal and epithelial tissues are tethered by collagen fibres which originate from pores in the bone. In a caprine model where the soft tissue interface of ITAP is porous, dermal and epithelial integration occurs creating a seal and preventing infection. In two clinical veterinary cases an ITAP implant has been successfully used in trans-radial canine amputees. A human trans-humeral amputee who previously could not wear their exo-prosthesis has been treated with ITAP. The surgery was single stage procedure and involved the insertion of an uncemented intramedullary stem into the residual humerus. A porous flange structure positioned adjacent to the dermal tissue which had most of the hypodermis removed was used to promote soft tissue ingrowth. At two years9 post-operation the skin seal has been maintained, there has been no incidence of infection, the patient wears their exo-prostheses for over 8 hours a day and has an almost complete range of shoulder motion. The use of ITAP device in selected cases may revolutionise the way amputees are surgically treated, lead to increased activity levels and more normal life styles in these patients.

Plastic and Reconstructive Surgery, Oct 1, 2019

Volume 144, Number 4 • Viewpoints 725e may be more difficult to insert in female patients with ve... more Volume 144, Number 4 • Viewpoints 725e may be more difficult to insert in female patients with very thin overlying skin or in secondary and tertiary rhinoplasties, again where the nasal skin is thin. Usually four or five quilting sutures are inserted prior to wound closure. The first stitch applies the overlying skin to the nasal tissue/septum at the level of the upper lateral cartilages (Fig. 1). A second suture is inserted opposing the lower lateral cartilages to the skin. Occasionally, an additional suture is inserted between these two sutures. Finally, two sutures are inserted laterally between the middle of the lower lateral cartilages and the nasal skin. We have used quilting sutures in nine consecutive patients undergoing septorhinoplasty via an open approach. The average patient age was 34 years (range, 18 to 63 years). All except two patients underwent medial and lateral osteotomies as well as tip maneuvers. The wounds were closed and then Micropore tape (3M, St Paul, Minn.) was applied to the nasal dorsum, followed by a thermostatic splint. In all cases, a 5/0 Monocryl suture was used as the quilting suture. There have been no complications after a mean follow-up of 5 months. Quilting sutures may also have a value in open rhinoplasty. It adds about 5 minutes of operating time.

Journal of Plastic Reconstructive and Aesthetic Surgery, Sep 1, 2007

Journal of Plastic Reconstructive and Aesthetic Surgery, Oct 1, 2021

BACKGROUND Prominent ear deformity is common amongst the human population and is partly due to un... more BACKGROUND Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.

Journal of Craniofacial Surgery, 2018

Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty ... more Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty to correct cranial defects following trauma or cranial surgery. Perfect intraoperative immobilization of the MM-BC is crucial to ensure correct subsequent shaping to best improve contour defects. Current immobilization techniques reported are time-consuming and involve complex metalwork. The authors hereby present a technique that may simplify the immobilization process by using histoacryl glue to secure the MM-BC. This provides a quick, inexpensive, and readily available option providing fixation strong enough to withstand final shaping of the MM-BC.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2017

Journal of Plastic Reconstructive and Aesthetic Surgery, Jul 1, 2018

Laryngoscope, Apr 15, 2018

Journal of Plastic Reconstructive and Aesthetic Surgery, Apr 1, 2007

Annals of The Royal College of Surgeons of England, Oct 1, 2014

Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extreme... more Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma's local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.

Journal of Plastic Reconstructive and Aesthetic Surgery, Oct 1, 2014

PubMed, Dec 1, 2000

Monoclonal antibodies (MAbs) against high-molecular-weight melanoma-associated antigen (HMW-MAA) ... more Monoclonal antibodies (MAbs) against high-molecular-weight melanoma-associated antigen (HMW-MAA) have been used in vivo to target melanoma. More recently, single chain Fv (scFv) antibody fragments against HMW-MAA have been described that may improve melanoma targeting. However, there have been few in vivo studies with antimelanoma scFvs because these have proved difficult to label with isotopes (e.g., 99mTc) suitable for imaging. We have generated a series of scFvs against HMW-MAA by chain shuffling and antibody phage selection on melanoma cells. In preliminary experiments we identified one scFv (RAFT3) as suitable for in vivo melanoma targeting. Direct radiolabeling of RAFT3 scFv with 99mTc was simple, yielding a radiochemical purity of >90%. The label remained stable for 24 h in vitro. 125I- and 99mTc-labeled RAFT3 scFv were tested in a nude mouse xenograft model for human melanoma and were compared with the parent MAb LHM2 and its F(ab')2 fragment versus nonmelanoma-specific MAb and scFv. RAFT3 scFv accumulated specifically in the tumor and showed greater tumor specificity compared with LHM2 with faster pharmacokinetics (t(1/2)alpha, 8 min; t(1/2)beta, 189 min; and t(1/2)alpha, 37 min; t(1/2)beta, 384 min, respectively) and reduced background in liver, lung, and spleen. Nonspecific accumulation of 99mTc-labeled RAFT3 scFv in the kidney was high but tumor:normal tissue ratios were better compared with 125I-labeled RAFT3 scFv and LHM2 F(ab')2. Overall, tumor-targeting efficiency at equivalent time points was scFv > IgG > F(ab')2 in good agreement with previously described scFvs engineered for 99mTc labeling. We discuss the potential use of RAFT3 scFv for imaging and therapy of metastatic melanoma.

The journal of hand surgery, Dec 1, 1997

We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery ... more We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery fasciocutaneous flap as described by Becker and Gilbert (1988a; b). Although the territory supplied by the dorsal ulnar artery is 10 cm to 20 cm long by 5 cm to 9 cm wide, Becker and Gilbert suggested that flapsshould be confined to smaller dimensions. We have found that larger flaps (15 to 20 cm long and 5 to 8 cm wide) are feasible, extending the use of the flap to the radial side of the wrist and hand. However, problems were encountered with venous drainage and these larger flaps should be used with caution.

Journal of Plastic Reconstructive and Aesthetic Surgery, Apr 1, 2011

Access to effective surgical treatments such as breast reduction is often restricted on the groun... more Access to effective surgical treatments such as breast reduction is often restricted on the grounds of patient obesity. However, there is a lack of unambiguous data on the surgical risks of obesity in patients undergoing breast reduction. The aim of this study was to assess the relationship between patient obesity, as determined by body mass index (BMI), and surgical outcome following bilateral breast reduction (BBR). Retrospective review of case notes was conducted for 306 patients who underwent BBR in our unit over a 5-year period. BMI, resection weight, smoking history, technique, complications and outcomes were determined from records of follow-up assessment. Overall complication rate was 53.9%, with multiple complications of 22.9%. A significant increase in complications after BBR with increasing BMI was identified (p = 0.019 any complication, p = 0.002 multiple complications). The effect of BMI on multiple complications was significant and independent of resection weight (p = 0.031) and reduction technique (p = 0.020). Smoking was associated with higher wound dehiscence and multiple complications. We developed a model for predicting risk of complications based on key variables. Despite higher complications, there was no significant difference in aesthetic outcome at follow-up between the BMI groups. These findings add to the body of evidence that obesity is associated with an increased risk of post-operative complications. This has implications for surgeons and healthcare payers. However the majority of complications were minor and aesthetic outcomes were satisfactory in the majority of cases. The use of a 'target' BMI as exclusion criteria should therefore be treated with caution.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2011

We examined variations in the shape of the human ear according to age, sex and ethnic group with ... more We examined variations in the shape of the human ear according to age, sex and ethnic group with particular attention to ear prominence. 420 volunteers were recruited. Measurements included; head height and length, ear height and axis, antihelix taken off angle, earlobe length and width, ear width at the helical root and tragus. Prominence was measured at the helical root and tragus (conchomastoid angle, conchal bowl depth and helical-mastoid distance). Good symmetry was shown for all measurements. Ethnically Indian volunteers had the largest ears (both length and width), followed by Caucasians, and Afro-Caribbeans. This trend was significant in males (p<0.001), but not significant in females (p=0.087). Ears increased in size throughout life. Subjectively, only 2% of volunteers felt their ears were prominent compared to 10% in the opinion of the principal investigator. No objective measurements were identified that accurately predicted subjective perceptions of prominence. We found consistent trends in ear morphology depending on ethnic group, age and sex. Our study was unable to define an objective method for assessing ear prominence. Decisions about what constitutes a prominent ear should be left to personal and aesthetic choice.

Jpo Journal of Prosthetics and Orthotics, Mar 31, 2022

ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated im... more ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.

Journal of Hand and Microsurgery, Sep 29, 2021

Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bon... more Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008–2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature. Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data. Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study). Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.

Orthopaedic Proceedings, May 1, 2012

Problems associated with soft tissues of the stump and attachment of prosthetic devices for amput... more Problems associated with soft tissues of the stump and attachment of prosthetic devices for amputees remains a considerable problem. These problems are associated with the transmission of load through the soft tissues of the stump and difficulty in attaching the prosthetic device. Several devices have an osteointegrated transcutaneous prosthesis attached to the residual bone onto which an exo-prostheses is secured thereby transmitting load directly through the skeleton. Infection of these devices is a key issue. A biomimetic intraosseous transcutaneous device for amputees known as ITAP has been developed which is based on deer antler morphology. We have shown that in deer antlers the dermal and epithelial tissues are tethered by collagen fibres which originate from pores in the bone. In a caprine model where the soft tissue interface of ITAP is porous, dermal and epithelial integration occurs creating a seal and preventing infection. In two clinical veterinary cases an ITAP implant has been successfully used in trans-radial canine amputees. A human trans-humeral amputee who previously could not wear their exo-prosthesis has been treated with ITAP. The surgery was single stage procedure and involved the insertion of an uncemented intramedullary stem into the residual humerus. A porous flange structure positioned adjacent to the dermal tissue which had most of the hypodermis removed was used to promote soft tissue ingrowth. At two years9 post-operation the skin seal has been maintained, there has been no incidence of infection, the patient wears their exo-prostheses for over 8 hours a day and has an almost complete range of shoulder motion. The use of ITAP device in selected cases may revolutionise the way amputees are surgically treated, lead to increased activity levels and more normal life styles in these patients.

Plastic and Reconstructive Surgery, Oct 1, 2019

Volume 144, Number 4 • Viewpoints 725e may be more difficult to insert in female patients with ve... more Volume 144, Number 4 • Viewpoints 725e may be more difficult to insert in female patients with very thin overlying skin or in secondary and tertiary rhinoplasties, again where the nasal skin is thin. Usually four or five quilting sutures are inserted prior to wound closure. The first stitch applies the overlying skin to the nasal tissue/septum at the level of the upper lateral cartilages (Fig. 1). A second suture is inserted opposing the lower lateral cartilages to the skin. Occasionally, an additional suture is inserted between these two sutures. Finally, two sutures are inserted laterally between the middle of the lower lateral cartilages and the nasal skin. We have used quilting sutures in nine consecutive patients undergoing septorhinoplasty via an open approach. The average patient age was 34 years (range, 18 to 63 years). All except two patients underwent medial and lateral osteotomies as well as tip maneuvers. The wounds were closed and then Micropore tape (3M, St Paul, Minn.) was applied to the nasal dorsum, followed by a thermostatic splint. In all cases, a 5/0 Monocryl suture was used as the quilting suture. There have been no complications after a mean follow-up of 5 months. Quilting sutures may also have a value in open rhinoplasty. It adds about 5 minutes of operating time.

Journal of Plastic Reconstructive and Aesthetic Surgery, Sep 1, 2007

Journal of Plastic Reconstructive and Aesthetic Surgery, Oct 1, 2021

BACKGROUND Prominent ear deformity is common amongst the human population and is partly due to un... more BACKGROUND Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.

Journal of Craniofacial Surgery, 2018

Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty ... more Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty to correct cranial defects following trauma or cranial surgery. Perfect intraoperative immobilization of the MM-BC is crucial to ensure correct subsequent shaping to best improve contour defects. Current immobilization techniques reported are time-consuming and involve complex metalwork. The authors hereby present a technique that may simplify the immobilization process by using histoacryl glue to secure the MM-BC. This provides a quick, inexpensive, and readily available option providing fixation strong enough to withstand final shaping of the MM-BC.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2017

Journal of Plastic Reconstructive and Aesthetic Surgery, Jul 1, 2018

Laryngoscope, Apr 15, 2018